Medical Policies
Policies that are included in the FEP Medical Policy Manual.
The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. The Blue Cross and Blue Shield Association does not intend by the FEP Medical Policy Manual, or by any particular medical policy, to recommend, advocate, encourage or discourage any particular medical technologies. Medical decisions relative to medical technologies are to be made strictly by members/patients in consultation with their health care providers. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that the Blue Cross and Blue Shield Service Benefit Plan covers (or pays for) this service or supply for a particular member.
- 5.21.059 Iressa (gefitinib)
- 5.21.060 Nexavar (sorafenib)
- 5.21.061 Odomzo (sonidegib)
- 5.21.062 Afinitor and Afinitor Disperz (everolimus)
- 5.21.063 Sprycel (dasatinib)
- 5.21.064 Lonsurf (trifluridine tipiracil)
- 5.21.065 Yondelis (trabectedin)
- 5.21.066 Imlygic (talimogene laherparepvec)
- 5.21.067 Onivyde (irinotecan liposome injection)
- 5.21.068 Cotellic (cobimetinib)
- 5.21.069 Tagrisso (osimertinib)
- 5.21.070 Darzalex (daratumumab)
- 5.21.071 Ninlaro (ixazomib)
- 5.21.072 Portrazza (necitumumab)
- 5.21.073 Empliciti (elotuzumab)
- 5.21.074 Gleevec (imatinib)
- 5.21.075 Alecensa (alectinib)
- 5.21.076 Halaven (eribulin mesylate)
- 5.21.077 Tasigna (nilotinib)
- 5.21.078 Evomela (melphalan)
- 5.21.079 Cabometyx (cabozantinib)
- 5.21.080 Tecentriq (atezolizumab)
- 5.21.081 Targretin (bexarotene)
- 5.21.082 Erlotinib
- 5.21.083 Votrient (pazopanib)
- 5.21.084 Erbitux (cetuximab)
- 5.21.085 Vectibix (panitumumab)
- 5.21.086 Nilandron (nilutamide)
- 5.21.087 Rubraca (rucaparib)
- 5.21.088 Kisqali (ribociclib), Kisqali Femara Co-Pack (ribociclib & letrozole)
- 5.21.089 Bavencio (avelumab)
- 5.21.090 Zejula (niraparib)
- 5.21.092 Alunbrig (brigatinib)
- 5.21.093 Rydapt (midostaurin)
- 5.21.094 Imfinzi (durvalumab)
- 5.21.095 Sutent (sunitinib)
- 5.21.096 Rituxan Hycela (rituximab and hyaluronidase)
- 5.21.097 Nerlynx (neratinib)
- 5.21.098 Idhifa (enasidenib)
- 5.21.099 Vyxeos (daunorubicin and cytarabine)
- 5.21.100 Besponsa (inotuzumab ozogamicin)
- 5.21.101 Kymriah (tisagenlecleucel)
- 5.21.102 Mylotarg (gemtuzumab ozogamicin)
- 5.21.103 Aliqopa (copanlisib)
- 5.21.104 Verzenio (abemaciclib)
- 5.21.105 Yescarta (axicabtagene ciloleucel)
- 5.21.106 Calquence (acalabrutinib)
- 5.21.107 Lutathera (lutetium LU 177 dotatate)
- 5.21.108 Erleada (apalutamide)
- 5.21.109 Yonsa (abiraterone acetate)